WHAT WOULD MASLOW SAY?

As we delve deeper into the true meaning of Person Centered Care and Habilitative Dementia Care, we’ve come to understand that Dementia does not take away our Human needs. These needs are with us from the time of birth until we depart this life. We may reprioritize them over the years, and perhaps change routes in search of fulfillment of these needs, but still they remain.

Abraham Maslow summarized these Human needs in the form of a 5 Step Hierarchy known as Maslow’s Hierarchy of Needs. The first step of the Hierarchy are our most basic needs, IE: food, water, shelter. As we move up the Hierarchy the needs become a bit more complex, IE: the second step is Safety and Security, the third is Socialization (family, friends, belonging), the fourth is Self-esteem (confidence and respect from others), and at the top we have Self-actualization ( goals achieved, happy where we are, living what to us is an optimum life). These are needs which we want to satisfy, and goals we would all like to achieve. At the end of the day we are all Human beings, with Human needs, with or without Dementia.

For those of us living without the challenges of Dementia, we set our course to fulfill these needs in a way that makes sense to us, using our skills of logic, forward thinking, reasoning ability, and socialization skills. Some of these skills may be challenged with Dementia, but we’ve learned that Needs need to be met. Unmet, unfulfilled needs often lead to responsive reactions which we think of as “behaviors”.

Are we doing enough to help those living with Dementia to climb to the top of that Hierarchy and mitigate “behaviors” before they occur? Let’s take a look.

We’ve done a good job of ensuring that those in our care are provided with the most basic human needs, IE: food, clothing, shelter, and hydration, toileting. We can check “yes” to that box.

Let’s look at the second step of the hierarchy, Safety and Security. Are we meeting our resident’s needs, or just solving our own problems? We tend to view “safety and security” as making sure the keypad door locks are activated and checked as operational. We have smoke and carbon monoxide detectors. We have visitors sign-in at the front desk, weather alert drills, night checks, etc. All good practice…no argument with any of that. But, what about those in our care? What is their perception of “safety and security”? To many living with Dementia, safety and security refers to what is familiar to them. When many say “I want to go home”, they’re not necessarily referring to a physical building or street address. They’re trying to get back to a time and place when things were familiar to them and there was safety in that familiarity. When they were able to take comfort in the things that they recognized as part of their life. When they recognized themselves within the lives they’ve built. Back to a time when they were able to “place themselves” within their surroundings. Now, they may feel they’re facing an uncertain future with Dementia. As if they’re walking down a hallway and everything that was familiar and comforting to them is behind them, and going forward there is darkness and uncertainty. What are we doing to support them on this journey? To let them know and feel that we are there to support them come what may? If we want to provide a sense of safety and security for them, it goes further than making sure the door alarms are activated. Safety and Security must incline a sense that whatever turns their lives may take with Dementia, we will be there to support them.

The third step, Socialization, is one we have taken to mean an activity calendar filled with lots of “fun” things to do. Do they think the activities are fun? Have we asked them what they would like to do, or just decide for them that they will enjoy what we’ve prepared? How do they interact with group dynamics? Are they within a group which will give them a sense of comradeship , or are they being bullied or excluded within the group? Are the activities too advanced for their skill set to provide a sense of accomplishment, or too simple to provide stimulation and growth? Do we provide opportunities for them to socialize with a non-dementia population? For example do we buy the flowers for the courtyard gardens, or do we arrange to have them join us on a trip to the garden center to make their own selections while interacting with workers and other customers who are not living with Dementia? We have themed cultural activities at our Communities with great food tastings of different cultures. That’s good, but how about an outing for lunch at a Chinese or Italian or other culturally themed restaurant? Socialization cannot take place in a bubble.

The fourth step is Self-esteem. Don’t we all strive for that? Don’t we all want to feel that we are valued and important members of our families and society in general? That our opinions matter and are valued by others? That’s a hard hill to climb when a person is constantly corrected and redirected. Do we take the time to ask for their contributions and suggestions. Do we provide an avenue to do good for the greater community, such as having Residents organize and run a food, clothing or book drive? Do we accept their timelines and their version of reality and how we fit into their version, or are we constantly trying to bring them into our present reality? Are we intent on correcting their version of events? When we continue to try and re-orient them to our non-dementia reality, all we are doing is perpetually telling them that they are wrong. Where is the self-esteem in that?

Finally, the fifth and top spot in the Hierarchy is Self Actualization. The feeling that we have attained our goals, are living an optimal life, and are happy with where we are along our own personal journey in life. A sense of achievement. How do we provide for this quintessential need in the scope of human fulfillment when we have taken away the life one has known, given them a new set of rules to follow (our rules…to keep them safe of course), and limited their ability to do what they want in favor of what we think they must want? In order to ensure this final step on the hierarchy, we must see each person as an individual human being. An individual human being who shares the same set of needs with all of us, with or without Dementia. We must see the person, not just the challenges of their Dementia. We must focus on the many strengths which remain and build upon them so growth doesn’t stop with a Dementia diagnosis. Dementia has been referred to as “the long goodbye”. What does that say about our perception of Dementia? That one who is diagnosed should have their life stop at the moment of diagnosis? We’ll never help them achieve fulfillment towards Self Actualization if we see it that way. Life is a “long goodbye”, yet we want to live it to the fullest. Our Human needs incline us to do so. Dementia needs are, in fact Human needs. We are all the same in that respect. Persons living with Dementia are deserving of the same opportunities to live their lives to the fullest, and achieve a sense of Self Actualization. Dementia may present challenges, but it does not take away one’s life. Let’s be sure we don’t either.